Recording and Reporting in MDR TB - Stop TB Partnership · Recording and Reporting in MDR TB Dominican Republic Experience Dra. María Rodríguez Technical National Unit for MDR TB

Recording and Reporting in MDR TBRecording and Reporting in MDR TBDominican Republic ExperienceDominican Republic Experience

Dra. MarDra. Maríía Rodra RodrííguezguezTechnical National Unit for MDR TBTechnical National Unit for MDR TB

6th Meeting of the Stop TB Working Group on MDR

Tbilisi, Georgia 20-22 September 2007

�� Area: 48,670.82 kmArea: 48,670.82 km22

�� Population Density: 175 habitants x KmPopulation Density: 175 habitants x Km22

�� Population: 9,100,183 (2006)Population: 9,100,183 (2006)

�� Annual Growing rate: 1,6%Annual Growing rate: 1,6%

�� 63% urban population.63% urban population.

�� 9 Health Regions with 30 DPS y 8 Areas in SD ( Total 38)9 Health Regions with 30 DPS y 8 Areas in SD ( Total 38)

�� 1200 health establishments (public system)1200 health establishments (public system)

Dominican RepublicDominican Republic

TB cases notified TB cases notified Dominican Rep. 2005Dominican Rep. 2005

29492949

53125312

NumberNumber

3333New SS+New SS+

5757All casesAll cases

RateRate

Source: WHO Global Report. 2007

SS(+): Sputum Smear Positive

DOTS Coverage and New SS(+) Case DOTS Coverage and New SS(+) Case Detection Rate, Dominican Rep.1999Detection Rate, Dominican Rep.1999--

20052005

0

10

20

30

40

50

60

70

80

90

1999 2000 2001 2002 2003 2004 2005

DOTS Coverage(%)

Detection Rate (%)

76%

Sources: WHO Global Report. 2007, National Tuberculosis Control Program – SESPAS – RD

0%

20%

40%

60%

80%

100%

Death 4.4 4.9 4.7 4.5 3 3.9

Failure 1.3 1.8 1 2 1.5 1.5

Transferred 3.7 3.2 4.2 3.3 2.7 2.5

Default 14.9 12.5 12.7 10.7 9.7 7.2

Completed TX 29.9 20.9 17.3 7.4 7.6 4.4

Cured 45.8 56.7 60.1 72.5 74.7 80.3

2000 2001 2002 2003 2004 2005

Total # 2617 2569 2474 2269 2593 2691

75.777.6 77.4

79.981.3

84.7

NewNew SmearSmear Positive Positive CohortCohort2RHZE/4R2RHZE/4R33HH33. . D.RD.R. . 20002000 –– 2005.2005.

SourceSource: : NationalNational Tuberculosis Control Tuberculosis Control ProgramProgram –– SESPAS SESPAS –– RDRD

USA 1.2%

CUBA 0,3%

PERU 3.0%

PR2.5%

NIC 1.2%

R.DOM 6.6%

ARG

1.8%

URU

0.01%

BRA 0.9%

(MDR-TB < 3%)

Initial MDR Resistance (Américas, 1994–2002)

CHI 0.6%

BOL 1.2%

CAN 1.2%

COL 1.47%

VEN 0.3%

ECU 5.0%

ELS0.3%

HON 1.8%

(MDR-TB =< 1%)

(MDR-TB >= 3%)

NO data

GUA 3.7%

Source: Situación Epidemiológica de la TB OPS/OMS 2004

MEX 3 estados 2.4%

Beginning of the programmatic Beginning of the programmatic management of MDR TB,2005management of MDR TB,2005--20062006

�� GLC approval for acquisition of second line drugsGLC approval for acquisition of second line drugs

�� Global Fund financial aidGlobal Fund financial aid

�� Designation of a National Technical MDR TB Unit Designation of a National Technical MDR TB Unit responsibleresponsible

�� Creation of the National Evaluation Committee (CONE TB Creation of the National Evaluation Committee (CONE TB MDR)MDR)

�� Actualization of the Category IV patientActualization of the Category IV patient’’s censuss census

�� Evaluation of all cases Evaluation of all cases

�� Elaboration and validation of the national guidelinesElaboration and validation of the national guidelines

�� Meetings of CONE TB MDRMeetings of CONE TB MDR

�� Training of health personalTraining of health personal

IndicationIndication ofof TB TB TreamentsTreamentsRegimentsRegiments, , DomincanDomincan RepRep. 2007. 2007

New patientsNew patients Category ICategory I

((2RHZE/4R3H3)2RHZE/4R3H3)

Category IICategory II

(2SRHZE/1RHZE/5R(2SRHZE/1RHZE/5R33HH33EE33))

Standardized Category IVStandardized Category IV

((KmZOfxEthCs/OfxEthCsKmZOfxEthCs/OfxEthCs))

Individualized Category IVIndividualized Category IV

Failures Category I in DOTFailures Category I in DOT

Failures Category IIFailures Category II

Treatment after default Treatment after default witnwitn DSTDST

Relapses with DSTRelapses with DST

Contacts of Standardized Category IV Contacts of Standardized Category IV

Treatment after defaultTreatment after default

RelapsesRelapses

Failures Cat. I no DOTFailures Cat. I no DOT

Failure to Standardized Category IV Failure to Standardized Category IV

Chronics who used Second Line drugsChronics who used Second Line drugs

Contacts of Individualized patientsContacts of Individualized patients

Information ManagementInformation Management

Category IV patientsCategory IV patients

�� Instruments recommended from WHO, Instruments recommended from WHO,

similar to those used for the sensitive similar to those used for the sensitive

patientspatients

�� Non computerized systemNon computerized system

�� Centralized informationCentralized information

Category IV PatientsCategory IV Patients

Registration instruments:

1. Initial evaluation form and Case Summary,Evolution form (Clinical records)

2. Assistance control card (Treatment card)

4. Registration “book” of Category IV

Case SummaryCase Summary

Drug history sheet, Case SummaryDrug history sheet, Case Summary

Author: Dr. José Caminero Luna

Assistance control card

ItIt containscontains::�� Demographic informationDemographic information

�� Summary of preview treatmentsSummary of preview treatments

�� Summary of CONE meeting and decisionsSummary of CONE meeting and decisions

�� HIV informationHIV information

�� Bacteriology resultsBacteriology results

�� Treatment regimentTreatment regiment

�� Number and dates of doses takenNumber and dates of doses taken

�� Treatment resultTreatment result

�� Contacts controlContacts control’’ss

�� AppointmentsAppointments

�� Follow up after treatmentFollow up after treatment

Two Excel files Two Excel files

1.1. One with all registered cases One with all registered cases MDR suspect, some later MDR suspect, some later excluded when DST shows no excluded when DST shows no MDRMDR

2.2. Another with cases starting Another with cases starting treatmenttreatment

Category IV Register

Category IV PatientsCategory IV PatientsReports:

1. Quarterly case report and

annual consolidate

2. Preliminary outcome report (9

months after last quarter day)

3. Annual report of treatment

outcome ( 24-36 after period)

Casereport, annual consolidate Dominican Rep,2006

Nombre de la Unidad de Salud PNCT-REP DOMINICANA Trimestre 01-02-03-04

Nombre del Distrito Año 2006

Número del Distrito

Nombre del Coordinador del Distrito Dra. María Rodríguez 181

Firma Fecha: 14/09/2007

Bloque 1: Pacientes registrados en la Categoría IV y pacientes que iniciaron tratamiento Categoría IV

TB MDR

confirmad

Sospecha

TB MDR

137 30

24 0

Bloque 2: Casos de TB MDR confirmados durante el Trimestre por historia de tratamiento anterior

Recaída

Despúes

de

Abandono

Después de

Fracaso al

1er.

Tratamient

Después de

Fracaso al

Retratamie

nto

2 13 7 46 55 0 14 137

Extrapul

monar

nuevo

Total Pacientes Cat IV

Informe trimestral de registro de casos de Categoría IV

Nuevo

Antes tratados

Pacientes

Registrados durante el Año como Categoría IV

Que iniciaron tratamiento Categoría IV durante el Año

Otros* Total

TB Pulmonar

Preliminary outcome reportYear 2006, Dominican Rep.

Nombre de la Unidad de Salud PNCT-REP DOMINICANA Trimestre 01-02-03-04

Nombre del Distrito Año 2006

Número del Distrito

Nombre del Coordinador del DistritoDra. María Rodríguez Total Pacientes Cat IV 181

Firma Fecha: 14/ 09 / 09

Cultivo

negativo

Cultivo

positivo

Cultivo

desconoci

do

Cultivo

negativo

Cultivo

positivo

Cultivo

desconoci

do

Cultivo

negativo

Cultivo

positivo

Cultivo

desconoci

do

FallecidoAbandon

o

Transfere

ncia sin

confirmarTB MDR

confirmada 2416 1 0 0 1 0 1 0 3 2 0 0

TB MDR

sospechosa 0 0 0 0 0 0 0 0 0 0 0 0 0

Total24 16 1 0 0 1 0 1 0 3 2 0 0

Evaluación preliminar de tratamiento de Categoría IV a los 6 meses

(llenado 9 meses después del inicio de tratamiento)

Egresados durante el trimestreBaciloscopia y cultivo a los 6 meses de tratamiento

Baciloscopia Negativa Baciloscopia Positiva Baciloscopia Desconocida

Número

de

pacientes

que

iniciaron

tratamient

ObservationsObservations

�� Instruments are simple and easy to completeInstruments are simple and easy to complete

�� Patients reported in one period that did not start Patients reported in one period that did not start treatment until next: 48 patients reported in treatment until next: 48 patients reported in 2006 have started treatment in 2007 2006 have started treatment in 2007

�� Follow up report of patients reported in one Follow up report of patients reported in one period that did not start treatment: 55 patients period that did not start treatment: 55 patients reported in 2006 have died in waiting list (48 reported in 2006 have died in waiting list (48 confirmed MDR).confirmed MDR).

�� More Intermediate results needed before final More Intermediate results needed before final reportreport

�� A computerized system would be very A computerized system would be very convenient.convenient.